title: Arterial switch operation with unidirectional valved patch closure of ventricular septal defect in patients with transposition of great arteries and severe pulmonary hypertension.
abstract: OBJECTIVE
  For patients with dextro-transposition of great arteries (d-TGAs), ventricular septal defect (VSD), and severe pulmonary arterial hypertension (PAH), the common surgical options are palliative arterial switch operation (ASO) or palliative atrial switch operation leaving the VSD open. We evaluated the role of ASO with VSD closure using a fenestrated unidirectional valved patch (UVP).
  
  
  METHODS
  Between July 2009 and February 2011, six patients with TGAs, VSD, and severe PAH (mean age 39.8 ± 47.4 months, median 21, range 8-132 months), weighing 10.7 ± 9.2 kg (median 8.6, range 4.3-29 kg), underwent ASO with VSD closure using our simple technique of UVP. Mean pulmonary artery systolic pressure before the operation was 106 ± 12.7 mm Hg (median 107.5, range 95-126 mm Hg) and pulmonary vascular resistance was 9.5 ± 4.22 units (median 9.5, range 6.6-17.1 Wood units).
  
  
  RESULTS
  There were no deaths. All patients had a postoperative systemic arterial saturation of more than 95%, although there were frequent episodes of systemic desaturation due to right-to-left shunt across the valved VSD patch (as seen on transesophageal and transthoracic echocardiograms). Mean follow-up was 10 ± 7.6 months (median 7.5, range 1-22 months). At most recent follow-up, all patients had systemic arterial saturation of more than 95% and no right-to-left shunt through the VSD patch. In one patient, the follow-up cardiac catheterization showed a fall in pulmonary artery systolic pressure to 49 mm Hg.
  
  
  CONCLUSIONS
  Arterial switch operation with UVP VSD closure is feasible with acceptable early results. It avoids complications of palliative atrial switch (arrhythmia and baffle obstruction) and partially or completely open VSD.
authors.affiliation: Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.forename: Vinitha Viswambharan
authors.initials: VV
authors.lastname: Nair
authors.forename: Sandeep
authors.initials: S
authors.lastname: Chauhan
authors.forename: Shyam Sunder
authors.initials: SS
authors.lastname: Kothari
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
keywords: arterial switch operation; congenital heart disease (CHD); congenital heart surgery; pulmonary vascular resistance/hypertension